The Operating Theatre Journal - Flipbook - Page 33
From the 541 responses:
● adhesive tape was the most commonly used material fixation (90.4%,
n=489)
● 61% (n=329) applied in the shape of the letter X
● 65% (n=351) experienced ETT displacement
● 4.3% (n=23) of displacements caused serious harm
As noted above, the use of adhesive tape (AT) and ETT fasteners was
explored by Landsperger et al in a pragmatic, single-centre, randomised
trial (Landsperger 2019) They found that the ETT was dislodged 3.9%
(n=6) and 10.3% (n=15) (incidences of 11.9 and 28.1 per 1000 ventilator
days,) respectively and concluded that ‘The use of the endotracheal
tube fastener…reduces the rate of a composite outcome that included
lip ulcers, facial skin tears, or endotracheal tube dislodgement
compared to adhesive tape.
Davies et al (2014) that, due to increased resistance to inadvertent
extubation forces via a maximised adhesive surface area, the most
secure method of fixing the airway was to tape to the mandible and
the maxilla.
Resource consequences
The clinical issues arising from inappropriately secured ETTs carry
a resource cost. While a roll of adhesive tape may be a low-cost
method of ETT fixation, its potential as a source of infection must be
considered. For example, in a study to ascertain the cost of treating
ventilator-associated pneumonia post cardiac surgery in the National
Health Service, Luckraz et al determined that the additional cost of
treating patients with ventilator-associated pneumonia was £8829
(Luckraz 2018).
Solution
While alternatives to cloth and adhesive tapes have been developed,
such as the AnchorFast, Comfort-Fix and the Thomas Select tube
holder, the latter of which can secure both ETT and other supraglottic
devices. However in terms of cost and ease of use, these fall short in
terms of price and ease of use:
● Anchorfast relies on a click security clamp to secure. The Slim costs
£13.20 per unit, the Standard costs £11 per unit and the straps are
£1.10. This is ordered through ORACLE rather than NHS supplies
● Comfort Fix relies on Velcro, a potential fomite, to secure in place
● The Thomas Select holder, £4.80 relies on a screw mechanism to
secure in place.
Developed by two Operating Department Practitioners, the singleuse LEAFix (Laryngeal, Endo-tracheal Airway Fixator), unlike other
tape alternatives, secures both generations of supraglottic airway. As
suggested by Davies et al (2014), the innovative ‘Y’ section secures the
airway device to both the maxillary and mandibular borders (Box 2).
Leafix is used in a similar way to adhesive tape and therefore offers
a focal point for standardising the practice of securing airways and
ensuring a safer clinical environment in airway securement (Figure 1).
Conclusion
The current random use of tape is dependent on the random actions
of an individual, meaning there is a lack of consistency in application.
Leafix can change this, providing a safer clinical environment for airway
securement. It is clear from the evidence that ETT fixation requires
national guidance to avoid extubation, infection and skin damage.
Leafix offers a safe and simple way of achieving these requirements.
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